ArticleBMC public health2022
Amplified effect of social vulnerability on health inequality regarding COVID-19 mortality in the USA: the mediating role of vaccination allocation.
Article in BMC public health, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed, 15 citations in OpenAlex.
- Contributions of prior health and vaccination to inequality in COVID-19 mortality by income: analysis of administrative microdata for the non-institutionalized Dutch population.International journal of epidemiology · 2026Article
- The role of vaccination, underlying health conditions, and working in healthcare in the socioeconomic disparities in COVID-19 hospitalization: a mediation analysis using interventional effect models.BMC infectious diseases · 2026Article
- An investigation into the impact of temporality on COVID-19 infection and mortality predictions: new perspective based on Shapley Values.BMC medical research methodology · 2025Article
- Article
- Social vulnerability index associated with higher COVID-19 seroprevalence in Nigeria.Global health action · 2024Article
- Association Between Social Vulnerability and Streptococcus pneumoniae Antimicrobial Resistance in US Adults.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2024Article
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- Article
- Estimating county-level flu vaccination in the United States.medRxiv : the preprint server for health sciences · 2023Article
Corrections and comments
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Authors and funding
4 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundVaccination reduces the overall burden of COVID-19, while its allocation procedure may introduce additional health inequality, since populations characterized with certain social vulnerabilities have received less vaccination and been affected more by COVID-19. We used structural equation modeling to quantitatively evaluate the extent to which vaccination disparity would amplify health inequality, where it functioned as a mediator in the effect pathways from social vulnerabilities to COVID-19 mortality.
methodsWe used USA nationwide county (n = 3112, 99% of the total) level data during 2021 in an ecological study design. Theme-specific rankings of social vulnerability index published by CDC (latest data of 2018, including socioeconomic status, household composition & disability, minority status & language, and housing type & transportation) were the exposure variables. Vaccination coverage rate (VCR) during 2021 published by CDC was the mediator variable, while COVID-19 case fatality rate (CFR) during 2021 published by John Hopkinson University, the outcome variable.
resultsGreater vulnerabilities in socioeconomic status, household composition & disability, and minority status & language were inversely associated with VCR, together explaining 11.3% of the variance of VCR. Greater vulnerabilities in socioeconomic status and household composition & disability were positively associated with CFR, while VCR was inversely associated with CFR, together explaining 10.4% of the variance of CFR. Our mediation analysis, based on the mid-year data (30
conclusionsAllocation of COVID-19 vaccination in the USA during 2021 led to additional inequality with respect to COVID-19 mortality. Viable public health interventions should be taken to guarantee an equitable deployment of healthcare recourses across different population groups.
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